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Resource Profile: US Core ADI DocumentReference Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-adi-documentreference Version: 0.1.0
Active as of 2023-10-17 Computable Name: USCoreADIDocumentReferenceProfile

​The US Core ADI DocumentReference Profile inherits from the FHIR DocumentReference resource; refer to it for scope and usage definitions. This profile and the US Core Observation ADI Documentation Profile meet the U.S. Core Data for Interoperability (USCDI) Advance Directive Observation Data Element requirements. It sets minimum expectations for searching and fetching patient Advance Directive Information (ADI) documents using the DocumentReference resource. Examples of advance healthcare directive documents include physician order for life sustaining treatment (POLST), do not resuscitate order (DNR), and medical power of attorney. In addition to the document contents, it communicates the type of advance directive document, the author, the verifier, and other properties. To represent whether advance directive documents exist for a patient, see the US Core Observation ADI Documentation Profile. This profile sets minimum expectations for searching and fetching patient ADI documents using the DocumentReference resource. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:adi SΣ 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice DocumentReference A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension Content/Rules for all slices
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... identifier S 0..* Identifier Other identifiers for the document
... status S 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... Slices for category S 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
.... category:adi S 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject S 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date S 0..1 instant When this document reference was created
... author S 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... authenticator 0..0
... content S 1..* BackboneElement Document referenced
.... attachment SC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType S 0..1 code Mime type of the content, with charset etc.
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SC 0..1 url Uri where the data can be found
.... format S 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
... identifier SΣ 0..* Identifier Other identifiers for the document
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: CompositionStatus (required): Status of the underlying document.
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:adi SΣ 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 string Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
Example General: text/plain; charset=UTF-8, image/png
..... language Σ 0..1 code Human language of the content (BCP-47)
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding

Example General: en-AU
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... size Σ 0..1 unsignedInt Number of bytes of content (if url provided)
..... hash Σ 0..1 base64Binary Hash of the data (sha-1, base64ed)
..... title Σ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation Σ 0..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
... context Σ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter 0..* Reference(Encounter | EpisodeOfCare) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... period Σ 0..1 Period Time of service that is being documented
.... facilityType 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
.... practiceSetting 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
.... sourcePatientInfo 0..1 Reference(Patient) Patient demographics from source
.... related 0..* Reference(Resource) Related identifiers or resources

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.docStatus Base required CompositionStatus 📍4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
DocumentReference.securityLabel Base extensible SecurityLabels 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.context.​event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.context.​facilityType Base example Facility Type Code Value Set 📍4.0.1 FHIR Std.
DocumentReference.context.​practiceSetting Base example Practice Setting Code Value Set 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice DocumentReference A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:adi SΣ 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... content SΣ 1..* BackboneElement Document referenced
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
Example General: text/plain; charset=UTF-8, image/png
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice DocumentReference A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()

Differential View

This structure is derived from DocumentReference

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... Slices for extension Content/Rules for all slices
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... identifier S 0..* Identifier Other identifiers for the document
... status S 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... Slices for category S 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
.... category:adi S 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject S 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date S 0..1 instant When this document reference was created
... author S 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... authenticator 0..0
... content S 1..* BackboneElement Document referenced
.... attachment SC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... contentType S 0..1 code Mime type of the content, with charset etc.
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SC 0..1 url Uri where the data can be found
.... format S 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5

Constraints

Id Grade Path(s) Description Expression
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DocumentReference 0..* DocumentReference A reference to a document
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:attester S 0..* (Complex) Participant who has authenticated the accuracy of the document.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-DocumentReference.attester
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... masterIdentifier Σ 0..1 Identifier Master Version Specific Identifier
... identifier SΣ 0..* Identifier Other identifiers for the document
... status ?!SΣ 1..1 code current | superseded | entered-in-error
Binding: DocumentReferenceStatus (required)
... docStatus Σ 0..1 code preliminary | final | amended | entered-in-error
Binding: CompositionStatus (required): Status of the underlying document.
... type SΣ 1..1 CodeableConcept Kind of document (LOINC if possible)
Binding: Advance Directives Content Type . (extensible): Advance Directives Content Type
... Slices for category SΣ 1..* CodeableConcept Categorization of document
Slice: Unordered, Open by value:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
.... category:adi SΣ 0..* CodeableConcept ​Categorization of ADI document"
Binding: VSAC 2.16.840.1.113762.1.4.1115.25 . (required): Advance Healthcare Directive Categories Grouper. Note that other codes are permitted, see Required Bindings When Slicing by Value Sets
... subject SΣ 1..1 Reference(US Core Patient Profile S | Practitioner | Group | Device) Who/what is the subject of the document
... date SΣ 0..1 instant When this document reference was created
... author SΣ 0..* Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | US Core PractitionerRole Profile | US Core RelatedPerson Profile | Device) Who and/or what authored the document
... custodian 0..1 Reference(Organization) Organization which maintains the document
... relatesTo Σ 0..* BackboneElement Relationships to other documents
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code Σ 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
.... target Σ 1..1 Reference(DocumentReference) Target of the relationship
... description Σ 0..1 string Human-readable description
... securityLabel Σ 0..* CodeableConcept Document security-tags
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
... content SΣ 1..* BackboneElement Document referenced
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... attachment SΣC 1..1 Attachment Where to access the document
Constraints: us-core-6
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... contentType SΣ 0..1 code Mime type of the content, with charset etc.
Binding: Mime Types (required): The mime type of an attachment. Any valid mime type is allowed.
Example General: text/plain; charset=UTF-8, image/png
..... language Σ 0..1 code Human language of the content (BCP-47)
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding

Example General: en-AU
..... data SC 0..1 base64Binary Data inline, base64ed
..... url SΣC 0..1 url Uri where the data can be found
Example General: http://www.acme.com/logo-small.png
..... size Σ 0..1 unsignedInt Number of bytes of content (if url provided)
..... hash Σ 0..1 base64Binary Hash of the data (sha-1, base64ed)
..... title Σ 0..1 string Label to display in place of the data
Example General: Official Corporate Logo
..... creation Σ 0..1 dateTime Date attachment was first created
.... format SΣ 0..1 Coding Format/content rules for the document
Binding: HL7 ValueSet of Format Codes for use with Document Sharing (extensible)
... context Σ 0..1 BackboneElement Clinical context of document
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... encounter 0..* Reference(Encounter | EpisodeOfCare) Context of the document content
.... event 0..* CodeableConcept Main clinical acts documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
.... period Σ 0..1 Period Time of service that is being documented
.... facilityType 0..1 CodeableConcept Kind of facility where patient was seen
Binding: FacilityTypeCodeValueSet (example): XDS Facility Type.
.... practiceSetting 0..1 CodeableConcept Additional details about where the content was created (e.g. clinical specialty)
Binding: PracticeSettingCodeValueSet (example): Additional details about where the content was created (e.g. clinical specialty).
.... sourcePatientInfo 0..1 Reference(Patient) Patient demographics from source
.... related 0..* Reference(Resource) Related identifiers or resources

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DocumentReference.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.status Base required DocumentReferenceStatus 📦4.0.1 FHIR Std.
DocumentReference.docStatus Base required CompositionStatus 📍4.0.1 FHIR Std.
DocumentReference.type Base extensible Advance Directives Content Type . 📦20250323 VSAC v0.23
DocumentReference.category Base example Document Class Value Set 📍4.0.1 FHIR Std.
DocumentReference.category:adi Base required http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.25 Not Stated Unknown
DocumentReference.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
DocumentReference.securityLabel Base extensible SecurityLabels 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.contentType Base required MimeType 📍4.0.1 FHIR Std.
DocumentReference.content.​attachment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
DocumentReference.content.​format Base extensible HL7 ValueSet of Format Codes for use with Document Sharing 📦2.1.0 THO v6.5
DocumentReference.context.​event Base example v3 Code System ActCode 📦3.0.0 THO v6.5
DocumentReference.context.​facilityType Base example Facility Type Code Value Set 📍4.0.1 FHIR Std.
DocumentReference.context.​practiceSetting Base example Practice Setting Code Value Set 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error DocumentReference If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error DocumentReference If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error DocumentReference If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice DocumentReference A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
us-core-6 error DocumentReference.content.attachment DocumentReference.content.attachment.url or DocumentReference.content.attachment.data or both SHALL be present. url.exists() or data.exists()

 

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